BACKGROUND:Shoulder dysfunction after cardiac implantable electronic device (CIED) implantation may impair upper-extremity function and quality of life (QoL). Although a prior randomized trial demonstrated short-term benefits of early postoperative exercises, long-term outcomes remain unclear. AIM:To evaluate the 3-year efficacy and safety of an early postoperative shoulder exercise protocol after CIED implantation. METHODS:Of 92 patients randomized in the original trial, 82 completed the 3-year follow-up. Participants had completed a 6-week intervention consisting of pendulum exercises (PE), stretching & strengthening exercises (SSE) or standard care, without further structured exercise. Outcomes included Visual Analog Scale (VAS) pain scores, grip strength, shoulder flexion and abduction range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Physical and Mental Component Summary scores (PCS and MCS) of the 36-Item Short-Form Survey (SF-36). Lead-related complications were also assessed. RESULTS:VAS and SF-36 MCS scores were comparable across groups. However, compared with standard care, both exercise groups maintained superior outcomes at 3 years for grip strength (PE: +9.0 kgf; SSE: +9.0 kgf), shoulder flexion ROM (PE: +10.0°; SSE: +11.0°), shoulder abduction ROM (PE: +7.0°; SSE: +7.0°), QuickDASH (PE: -5.0 points; SSE: -6.0 points), and SF-36 PCS (PE: +9.0 points; SSE: +10.0 points) (all P < 0.05). No lead-related complications occurred during follow-up. CONCLUSION:Early postoperative shoulder exercise after CIED implantation provides sustained improvements in shoulder function and physical QoL without compromising lead safety. TRIAL REGISTRATION: CLINICALTRIALS:gov, NCT07496554. https://clinicaltrials.gov/study/NCT07496554.
Near-infrared spectroscopy (NIRS) is a technology capable of non-invasive, continuous measurement of regional tissue oxygen saturation (rStO2). No longer limited to the domain of laboratory research, this technology has become a routine bedside monitoring tool in neonatal intensive care units. The neonatal period is a unique stage in human life, during which the infant undergoes profound physiological adjustments essential for the transition from the intrauterine to the extrauterine environment. The temporal dynamics of regional cerebral tissue oxygenation during the first minutes after birth are among the most extensively investigated in contemporary neonatal research. This systematic qualitative review aims to summarize reference ranges defined as normal values or centile charts of cerebral oxygenation (cStO2) and cerebral fractional tissue oxygen extraction (cFTOE) during postnatal adaptation for term and preterm neonates. Systematic measurement and statistical evaluation of physiological values are essential for establishing benchmarks, especially for critically ill neonates.
AIMS:This study evaluates the feasibility of an artificial intelligence (AI)-assisted software tool for early identification and classification of chronic wounds and for supporting decisions on whether professional clinical review is needed. METHODS:A pilot assistive software solution was developed by integrating wound image analysis with patient-reported metadata. The system combines You Only Look Once (YOLO) for wound localization and U-Net for tissue segmentation. A standardized wound imaging and annotation protocol was designed in collaboration with the University Hospital Bulovka. Diagnostic performance will be evaluated using sensitivity, specificity, positive predictive value and negative predictive value. RESULTS:A Python-based prototype and a multimodal software architecture were developed. More than 500 standardized wound images have been collected to date, and the dataset is being expanded iteratively according to model performance, class balance, annotation quality and validation requirements. A regulatory certification strategy was outlined under the Medical Device Regulation and the AI Act. CONCLUSION:The study establishes a technical and regulatory foundation for future AI-based wound care tools intended to support earlier triage and professional assessment of chronic wounds.
BACKGROUND:Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular (CV) morbidity and mortality. Chronic low-grade inflammation has been identified as a pathophysiological link. Continuous positive airway pressure (CPAP) therapy successfully treats OSA and has positive effects beyond improving breathing patterns during sleep. However, its potential impact on CV morbidity and mortality remains unclear. OBJECTIVES:To determine the association between CV risk, the risk of incident malignancies, and the probability of patient death based on inflammatory parameters, anthropometry and OSA severity parameters, as well as the effectiveness of CPAP therapy. METHODS:We retrospectively analyzed data from 245 patients diagnosed with moderate-to-severe OSA, identified as having an apnea-hypopnea index ≥ 15/h. Adherence was defined as CPAP use ≥ 4 h/night for ≥ 70% of days. We assessed CV history, mortality, polysomnographic data and inflammatory parameters (C-reactive protein, leukocyte count, neutrophil-to-lymphocyte ratio [NLR], monocyte-to-lymphocyte ratio, and platelet-to-white blood cell ratio). Univariate and multivariate logistic regressions were used to identify independent predictors of CV outcomes, malignancy incidence and death within 10 years. RESULTS:Patients poorly adhering to CPAP therapy (39.2%) had significantly higher rates of CV complications (32.8% vs. 15.1%, P = 0.003), malignancies (19.7% vs. 8.3%, P = 0.018), and mortality (14.6% vs. 4.0%, P = 0.003). Non-adherence was a strong independent predictor of CV complications (odds ratio [OR] = 2.75, P = 0.004) and death (OR = 4.07, P = 0.006). In univariate analysis, age, non-adherence, and NLR were significantly associated with the risk of incident malignancy (P = 0.022-0.008); NLR was also significant in multivariate analysis (P = 0.008). The t90 index (time spent below 90% oxygen saturation) was an independent predictor of mortality (OR = 1.03, P = 0.003). CONCLUSIONS:Non-adherence to CPAP therapy is associated with an increased risk of CV complications, malignancies and death in OSA patients. Inflammatory markers and desaturation parameters (particularly t90) are valuable predictors that should be monitored in routine practice to identify high-risk patients. Implementing strategies to improve CPAP adherence may reduce long-term systemic inflammation and clinical risks.
PURPOSE:To report the approach, technical success, safety, and short-term outcomes of thoracic duct stenting for treating chylothorax and chylous ascites in a patient with Yellow Nail Syndrome. CASE REPORT:A 57-year-old male with Yellow Nail Syndrome, characterized by yellow thickened nails, lymphedema, and respiratory abnormalities, required repeated thoracocenteses for chylothorax. A thoracic duct intervention involving percutaneous transluminal angioplasty and balloon-expandable stent implantation via retrograde access was performed. Procedure characteristics, clinical success, complications, and follow-up were recorded. CONCLUSIONS:Thoracic duct stenting was a safe and technically successful procedure. After the procedure, the patient was relieved of symptoms. This technique could be considered for patients with recurrent chylothorax and chylous ascites, including those with Yellow Nail Syndrome. Further research is required to validate these findings.
BACKGROUND:Lipoprotein(a) (Lp(a)) is a cardiovascular risk factor (RF) with potentially high clinical impact. However, in the "real world", it remains largely overlooked, and the epidemiological circumstances of this RF have not yet been systematically studied in the Czech population. The aim of this study was to determine the prevalence of elevated values in cardiovascular patients and in the general population of this country. METHODS:A descriptive survey and case-control study were conducted on 2001 subjects [mean age 61.5 years (±SD 12.5); 62.9% males], 1016 cases-patients with manifest coronary heart disease, (CHD), and 985 controls-a random general population sample. RESULTS:The CHD patients had a significantly higher prevalence of increased Lp(a) (≥125 nmol/L) than the control group (25.1 vs 12.9%, P<0.0001). We found a similar relative difference using a lower cut-off, i.e., Lp(a) ≥105 nmol/L (28.9 vs. 14.6%, P<0.0001). In case-control analysis, fully adjusted odds ratio for Lp(a) ≥125 nmol/L was 1.69 (95%CI: 1.13-2.53, P=0.011), while for Lp(a) ≥105 nmol/L, 1.71 (95%CI: 1.16-2.52, P=0.006). Increased Lp(a) was also independent of other conventional RFs, and the only major coincidence we found was elevated LDL cholesterol. CONCLUSIONS:This study showed a significantly higher prevalence of Lp(a) in patients with manifest CHD compared to the general population. The systematic screening of this RF and pharmacologic intervention are probably warranted in routine clinical practice.
BACKGROUND:To investigate the association between atopic dermatitis (AD) and keratoconus (KC) in atopic dermatitis patients with no prior ophthalmologic diagnosis. METHODS:Thirty eyes of 30 patients with moderate to severe AD were included in this pilot study and compared to healthy controls (n=20) and patients with forme fruste KC (n=28). In the AD group, diagnosis of KC was based on clinical signs and corneal topography criteria such as inferior steepening (inferior-superior difference>1.45 D) and elevated maximum keratometry values (>47 D). Subclinical KC was defined by the presence of specific sensitive indices from corneal topography, tomography, or biomechanical assessments. Risk factors analyzed for ectasia development were the onset and severity of AD, sensitization to aeroallergens, systemic therapy, concomitant atopic diseases, eyelid eczema, and total IgE. RESULTS:We identified two manifest KC (6.7%), and six subclinical KC (20%) cases in patients with AD but with no previous diagnosis of KC. No overall differences were found in corneal tomography and biomechanics indices between control and AD patients. However, eye rubbing was not identified as a risk factor for developing ectasia in the AD group. CONCLUSION:Dermatologists should be aware that patients with moderate or severe AD may have a higher risk for developing corneal ectasia, particularly when eyelid eczema is present. The estimated prevalence of KC in patients with AD appears to be higher than that in the general population but more studies are needed.
INTRODUCTION:Intraoperative neurophysiological monitoring is a standard in surgeries with an increased risk of iatrogenic neurological injury development. The gold standard for this monitoring modality is propofol-based total intravenous anaesthesia (TIVA). Although there seems to be no clinically significant complication for propofol administration in patients with soy, egg, or peanut allergies, a whole range of recommendations still prohibit propofol administration in patients with these allergies. Remimazolam is a new, ultra-short-acting benzodiazepine that can potentially be an alternative in cases of propofol contraindications in need of TIVA. CASE REPORTS:We report two cases of a 19-year-old girl and a 17-year-old boy undergoing scoliosis surgery with transcranial motor evoked potentials monitoring (TcMEP). We chose remimazolam-based total intravenous anaesthesia due to the severe peanut and soy allergy, respectively. Total intravenous anaesthesia was maintained with remimazolam at a dose of 1.5-2 mg/kg/h and remifentanil at a dose of 0.5-0.8 µg/kg/min. Depth of anaesthesia was controlled using frontal EEG monitoring. TcMEP remained stable and showed no significant alterations throughout the surgeries. No new neurological deficits were detected after the surgeries. CONCLUSION:Our results show that remimazolam-based anaesthesia may be a safe alternative to propofol-based anaesthesia for surgeries with an intraoperative neurophysiological monitoring, or patients with propofol contraindications but more data are needed.
The Measles-Rubella-Zoster (MRZ) reaction is a test for the intrathecal synthesis of IgG antibodies against measles, rubella and varicella zoster viruses. Since the 1990s, it has been used as an adjunctive test to support the diagnosis of multiple sclerosis (MS), although it has no formal role in current McDonald diagnostic criteria and its clinical relevance remains debated. While early studies considered a single elevated antibody index (M, R or Z) as a positive result, the practice today requires at least two elevated antibody indices (M+R, M+Z, or R+Z), referred to as a polyspecific MRZ reaction (MRZ-2). MRZ-2 is the most specific laboratory marker for MS, with reported specificity exceeding 90%. However, sensitivity varies widely across studies, ranging from approximately 30% to over 70%. In the Czech adult MS population, MRZ-2 sensitivity was recently reported at 32%, markedly lower than the 67% pooled sensitivity reported in a meta-analysis of predominantly German cohorts. Broadening the panel of anti-viral antibodies (MRZ+) has been proposed to improve sensitivity, with parvovirus B19 and mumps virus being the most promising candidates. Further studies are required to determine whether an extended panel can increase sensitivity while maintaining high diagnostic specificity.
BACKGROUND:Heart failure with reduced ejection fraction (HFrEF) is mainly characterized by cardiac remodeling. Sacubitril/valsartan and Qili Qiangxin Capsules (QLQX a Chinese patent medicine, commonly used for the treatment of CHF with wide acceptance in Chinese patients), each benefit HFrEF alone, however, further high-quality clinical evidence is needed to confirm their combined effect on reversing cardiac remodeling. OBJECTIVE:To study the role of sacubitril/valsartan plus QLQX in reversing cardiac remodeling in HFrEF patients, and provide evidence for optimizing HFrEF treatment. METHODS:124 HFrEF patients were admitted to our hospital from Feb 2023 to Apr 2025. After exclusions, 118 were analyzed and divided by treatment (per electronic records) into two groups: sacubitril/valsartan (58 cases) and sacubitril/valsartan + QLQX (combined group, 60 cases). Primary outcomes included left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular global longitudinal strain (GLS), and serum N-terminal pro-brain natriuretic peptide (NT-proBNP). Secondary outcomes included serum cardiac troponin I (cTnI), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), clinical efficacy, 6-minute walking test (6MWT), Minnesota Living with Heart Failure Questionnaire (MLHFQ), and adverse events. RESULTS:The combined group showed significantly greater improvements in LVEF and absolute GLS (all P<0.001), greater reductions in LVEDD (P=0.026), LVESD (P=0.039) and NT-proBNP (P=0.020) than the monotherapy group. The combined group had greater reductions in CRP (P=0.003), TNF-α (P<0.001) and cTnI (P<0.001), a higher total clinical effective rate (P=0.008), a greater increase in 6MWT (P=0.025) and a greater decrease in MLHFQ score (P<0.001) than the monotherapy group. Adverse event incidence did not differ significantly between groups (P=0.431). CONCLUSION:Sacubitril/valsartan combined with QLQX effectively improves cardiac structure and function, boosts HFrEF patients' clinical efficacy and quality of life, and is well-tolerated. It offers a reliable option for optimizing HFrEF treatment.
INTRODUCTION:Ovarian tumours represent a highly malignant disease that is often diagnosed at an advanced stage and is associated with a poor prognosis. The most common histological type is high-grade serous carcinoma, characterized by significant genomic instability and homologous recombination defects, particularly due to pathogenic variants in the BRCA1 and BRCA2 genes. The introduction of high throughput sequencing methods has enabled the identification of a broader spectrum of predisposing genes and further emphasised the importance of genetic testing for targeted prevention and individualised treatment. METHODS:The aim of our study was to determine the frequency of germline mutations in 117 unrelated patients diagnosed with ovarian, tubal, or primary peritoneal cancer. We also assessed epidemiological and tumor pathogenesis data. The patients were examined with the "CZECANCA" gene panel sequenced by next-generation sequencing (NGS) on an Illumina platform. RESULTS:Pathogenic variants were found in 29% of patients, most commonly mutations in the BRCA1 and BRCA2 genes. The median age of patients with high-grade serous ovarian cancer was 61 years. The median age of BRCA1/2-positive women was 54 years, and all had a positive family history of cancer. CONCLUSION:Identifying carriers of pathogenic variants enables targeted prevention, earlier detection, and personalized therapy. Despite significant advances in treatment, early diagnosis and screening of at-risk individuals remain a major challenge.
BACKGROUND:Endometrial carcinogenesis involves complex interactions between hormonal signaling and the local immune microenvironment. While atypical endometrial hyperplasia is a recognized precursor to carcinoma, the spatial and phenotypic evolution of immune and hormonal markers during progression remains incompletely characterized. METHODS:A retrospective cohort of 150 endometrial specimens, including hyperplasia without atypia (n=40), hyperplasia with atypia (n=40), endometrioid carcinoma (n=40), and serous carcinoma (n=30), was analyzed using immunohistochemistry for CD3, CD4, CD8, FOXP3, CD68, CD163, estrogen receptor (ER), and progesterone receptor (PR). Digital whole-slide imaging and QuPath were applied to quantify immune cell densities in intratumoral and peritumoral compartments. Correlations between immune markers and hormonal receptors were evaluated, and a subgroup of 27 paired hyperplasia-carcinoma cases was analyzed separately. RESULTS:CD3+ and CD8+ T-cell densities increased progressively from hyperplasia to carcinoma (P<0.001), with hyperplastic lesions demonstrating predominant peritumoral localization consistent with immune exclusion. FOXP3+ regulatory T cells were enriched in neoplastic lesions, particularly in ER/PR-positive tumors. CD8+ intratumoral and peritumoral densities showed significant inverse correlations with ER and PR expression (both r=-0.76, P<0.001), whereas FOXP3+ infiltration correlated positively with ER and PR (r=0.64, P<0.001). M2 CD163+ macrophages demonstrated an inverse association with ER (r=-0.49, P<0.01), while M1 CD68+/iNOS macrophages showed no statistically significant correlations. In the paired subgroup, higher peritumoral than intratumoral CD8+ densities persisted, indicating residual immune exclusion despite malignant transformation. CONCLUSIONS:Endometrial neoplastic progression is characterized by a transition from peritumoral immune exclusion in hyperplasia to increased intratumoral immune infiltration in carcinoma, although this shift is not universal. Hormone receptor-positive tumors exhibit enrichment of FOXP3+ regulatory T cells and CD163+ macrophages, suggesting hormone-linked immune suppression. These findings highlight combined immune-hormonal biomarkers as potential indicators of progression risk and support further investigation of integrated immunomodulatory and hormone-targeted therapeutic strategies.
BACKGROUND:Chronic obstructive pulmonary disease (COPD) is now a major contributor to illness and death on a global scale. Traditional classifications based on pulmonary-function variables like the FEV1 (% predicted), lack sensitivity to early inflammatory changes and disease heterogeneity. In contrast, MiRNAs have emerged as promising biomarkers for respiratory conditions including COPD. The aim of this study was to examine the association between selected MiRNAs and COPD. METHODS:A total of 200 COPD patients (GOLD I-IV, n=50 each) and 50 healthy controls were enrolled. Differentially expressed miRNAs were identified from the GEO database and validated by RT-qPCR. Univariate analysis and LASSO regression were used for feature selection. A logistic regression model incorporating selected variables was established for the forecast COPD severity. KEGG pathway enrichment of miR-518b target genes was performed using DAVID. RESULTS:Five miRNAs (miR-216a, miR-518b, miR-106a, miR-1233, and miR-184) were substantially increased in COPD and correlated with disease severity (P<0.001). LASSO regression identified FEV1 (% predicted), DLCO (% predicted), CAT score, miR-518b, and age as key predictors. The combined model showed excellent classification performance (AUC=0.953; sensitivity=92.9%; specificity=81.3%). MiR-518b emerged as a strong independent risk factor (OR=18.91, P=0.003). Gene set enrichment of miR-518b targets pointed to involvement in both the Toll-like receptor and Hippo pathways, implicating its critical roles in inflammation and airway remodeling. CONCLUSIONS:MiR-518b is closely associated with COPD severity and may be useful in clinical practice. A model integrating miRNA expression and clinical parameters provides high predictive value for COPD classification and supports precision diagnosis.
BACKGROUND:The C-reactive protein-to-albumin ratio (CAR) has recently gained attention as a novel biomarker reflecting both systemic inflammation and nutritional status. Since inflammation plays a critical role in the formation of the coronary collateral circulation (CCC), this study aimed to investigate the association between CAR and the extent of CCC in patients with chronic coronary syndromes (CCS) and chronic total occlusion (CTO). METHODS:A total of 123 consecutive patients with CCS and angiographically documented CTO were included. CCC was assessed using the Rentrop classification and patients were divided into two groups: poor CCC (grades 0-1) and good CCC (grades 2-3). Laboratory data including C-reactive protein (CRP), albumin, lipid parameters, renal and liver function tests, glucose, and complete blood count were recorded. CAR was calculated by dividing CRP (mg/L) by albumin (g/dL), and neutrophil-to-lymphocyte ratio (NLR) was also evaluated. RESULTS:Patients with poor CCC had significantly higher CRP, CAR, and NLR levels (P<0.05 for all). In multivariate logistic regression, both CAR (OR=1.200, 95% CI: 1.102-1.394, P<0.001) and NLR were independently associated with poor CCC. ROC analysis showed that CAR had better predictive value (AUC=0.79) than CRP (AUC=0.75, P=0.02) and NLR (AUC=0.67, P=0.03). A CAR cutoff of 2.36 yielded 67% sensitivity and 68% specificity. CONCLUSION:Elevated CAR is independently associated with impaired CCC in patients with CCS and CTO. CAR may serve as a simple and superior marker over traditional inflammatory indices in assessing collateral vessel development.
A prosthetic arteriovenous graft (AVG) represents a type of vascular access for haemodialysis (HD), employing a synthetic conduit that replaces a native vessel and permits repeated cannulation. Due to their associated complications, particularly thrombosis and infection, arteriovenous grafts (AVGs) have long been regarded as a secondary option. Current recommendations advocate an individualized approach to vascular access planning based on patient´s anatomy, life expectancy, anticipated dialysis duration, and personal preferences, leading to a broader and more flexible use of AVGs. Their key advantage is the potential for early initiation of HD, while minimizing the need for central venous catheters. However, a major disadvantage of AVGs is their tendency to develop stenotic lesions, predominantly at the venous anastomosis, which adversely affects graft patency. If left untreated, this may lead to graft thrombosis. Regular evaluation of AVG function is essential for early detection of stenosis and maintenance of graft patency. Despite its widespread use in clinical practice, the role of AVG surveillance in vascular access management remains a subject of considerable debate, as current evidence regarding its effectiveness in preventing thrombosis and prolonging graft patency is inconclusive.
BACKGROUND:Ceramides are a heterogeneous group of bioactive membrane sphingolipids that play specialized regulatory roles in cellular metabolism depending on their characteristic fatty acyl chain lengths and subcellular distribution. Ceramides have emerged as promising biomarkers for cardiovascular diseases. METHODS:Within the prospective Kardiovize study based in Brno, Czech Republic, we aimed to develop two carotid intima-media thickeness (CIMT) prediction models using available variables. One model incorporated, in addition to sex and age, conventional biomarkers (total cholesterol, triglycerides, lipid-lowering therapy), while the other included blood concentrations of selected ceramides. Lipids species were measured by a hyphenated mass spectrometry technique. RESULTS:A total of 139 men (mean age 61.8 ± 16.4) and 222 women (63.9 ± 14.8) were included in the present study. Both approaches yielded almost identical coefficients of determination (54.6 % vs 55.0%) with good classification abilities (weighted kappa 0.69 vs 0.71) in both models. The ceramide (d18:1/18:0) shows a strong negative association with CIMT (β = -1.39, P=0.04), while (d18:1/24:1) shows a positive association with carotid intima-media thickness (β=0.20, P=0.002). CONCLUSION:The tested ceramides were able to predict subclinical atherosclerosis by carotid intima-media thickness with comparable accuracy to a combination of routinely tested lipids.
BACKGROUND:The no-touch (NT) technique for saphenous vein harvesting aims to preserve vascular integrity and improve graft performance in coronary artery bypass grafting (CABG). However, concerns remain regarding wound healing disorders and local complications at the graft harvest site. METHODS:This prospective observational comparative study included 60 consecutive patients undergoing CABG, allocated to conventional saphenous vein harvesting (CONV, n=30) or the NT technique (NT, n=30). Group allocation was based on routine clinical practice and surgeon preference, without formal randomization. The primary outcome was the incidence of wound healing disorders and local complications at the harvest site. Secondary outcomes included perioperative parameters, major adverse cardiovascular events (MACE), and venous graft patency assessed by computed tomography coronary angiography one year after surgery. RESULTS:Operative time and aortic cross-clamp time were comparable between groups. Shorter graft harvesting time was observed in the NT group (35 ± 7.5 min vs. 43 ± 9.1 min; P=0.001), along with significantly reduced perioperative blood loss (15 ± 7 mL vs. 40 ± 12.1 mL; P<0.0001). The incidence of subcutaneous hematoma on postoperative day 7 was significantly lower in the NT group (20% vs. 60%; P=0.003). No statistically significant differences were found between groups in wound infection rates, MACE, or venous graft patency at one-year follow-up. CONCLUSION:The NT technique for saphenous vein harvesting offers relevant perioperative advantages, including shorter harvesting time, reduced blood loss, and fewer early local complications, without adversely affecting operative time, major adverse cardiac events, wound infection, or one-year graft patency.
BACKGROUND AND AIMS:Suicide represents a major public health issue influenced by a complex interplay of individual, social, and environmental factors. While suicidological research traditionally focuses on psychological and clinical aspects, spatial dimensions of suicidal behavior remain less explored, particularly in Central Europe. This study presents a geospatial analysis of completed suicides in the Olomouc and Zlín Regions of the Czech Republic between 2018 and 2022, using a unique dataset derived from forensic autopsy records. The primary goal was to demonstrate the potential of spatial processing and interdisciplinary collaboration between forensic medicine and geoinformatics in identifying contextual patterns of suicidal behavior. METHODS:A dataset of 585 completed suicides was compiled from forensic autopsy reports, including detailed individual-level characteristics and geolocation data. Spatial analyses were conducted using GIS software, integrating additional layers such as land use, demographic and socioeconomic indicators, and quality of life indices. Both point-level and aggregated data (municipality and administrative district levels) were used to explore correlations and spatial variability. RESULTS:The study confirmed known trends - such as male predominance and the role of alcohol - and identified new spatial relationships, including a negative correlation between blood alcohol concentration and latitude, and between age and distance from residence to suicide location. Spatial analyses were conducted at multiple levels of aggregation and combined with selected socioeconomic and environmental indicators, including quality of life, urban-rural context, and foreclosure (enforcement) rates. The results demonstrate that spatial patterns and correlations between suicide rates and area-based characteristics vary depending on the spatial scale of analysis. CONCLUSION:The findings illustrate the potential of interdisciplinary collaboration between forensic medicine and geoinformatics and provide an exploratory basis for further research and more context-sensitive suicide prevention approaches.
AIMS:This study aimed to investigate the relationship between sleep parameters and tear film hydration assessed by tear meniscus height (TMH), and to evaluate the usability of a mobile application for remote behavioral and physiological data collection. METHODS:Eighteen healthy adults (mean age 29.6 ± 6.4 years) completed five consecutive days of linked measurements combining objective sleep tracking (using Fitbit Charge 4) and slit-lamp imaging of TMH under standardized conditions. Behavioral data on stress, caffeine intake, and smartphone use were collected via a custom mobile application, whose usability was assessed by the System Usability Scale (SUS). RESULTS:Ninety valid daily records were analyzed. TMH correlated positively with total sleep time (r=0.31, P=0.0033), REM sleep duration (r=0.28, P=0.0066), and sleep quality (r=0.32, P=0.0024). Each additional 30 min of REM sleep increased TMH by approximately 0.014 mm. Short sleepers (<6 h) showed significantly lower TMH (0.121 mm) than normal sleepers (≥6 h; 0.153 mm; P=0.0023). Stress and evening smartphone use were associated with reduced sleep quality and lower TMH. The mobile application achieved excellent usability (SUS = 87 ± 6). CONCLUSIONS:Our data indicate that sleep duration and architecture play essential roles in maintaining tear film stability. Behavioral habits that impair sleep continuity may thus directly affect ocular surface physiology. The combined use of wearable sensors and mobile self-reporting represents a practical approach to studying the interaction between sleep and ocular physiology.
BACKGROUND:Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urological disorder with a significant impact on quality-of-life. This study assessed the effects of rectal administration of dual cannabidiol (CBD)/hyaluronic acid (HA)-based therapy in men with CP/CPPS. METHODS:A single-arm, open-label pilot trial on 16 men (24-49 years) with CP/CPPS (NIH Chronic Prostatitis Symptom Index [NIH-CPSI] >10, pain subscore ≥4). The participants self-administered rectal CANNEFF® suppositories containing CBD (100 mg) and HA (6.6 mg) as active ingredients, nightly for 30 days. Outcome measures included changes in NIH-CPSI total score, International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5). Safety and tolerability were also assessed. RESULTS:The median baseline NIH-CPSI score was 24.5 points (range 11, 39) decreasing to a median 20.0 (range 2, 26) at day 30 (P=0.003), with a median reduction of 7.0 points (range -20.0, 6.0). Symptom improvement was found in 81.3 % (13/16) of participants. The IPSS total score decreased from a median of 14.0 points (range 4, 32) to a median 12.0 (range 3, 18) (P=0.033), with voiding symptoms showing the largest improvement. The IIEF-5 score increased modestly but without statistical significance. No adverse events were reported. CONCLUSIONS:The administration of the suppositories with CBD/HA action demonstrated potential symptom relief in CP/CPPS with a favourable tolerability profile. A more nuanced analysis of NIH-CPSI changes and IPSS and IIEF-5 data suggests a clinically meaningful benefit for most participants.
